U.S. patent application number 10/451535 was filed with the patent office on 2004-04-22 for method, arrangement and program for a prosthetic installation.
Invention is credited to Andersson, Matts, Brajnovic, Izidor.
Application Number | 20040078212 10/451535 |
Document ID | / |
Family ID | 20282459 |
Filed Date | 2004-04-22 |
United States Patent
Application |
20040078212 |
Kind Code |
A1 |
Andersson, Matts ; et
al. |
April 22, 2004 |
Method, arrangement and program for a prosthetic installation
Abstract
In a method and arrangement for allocating prosthetic
installation work between at least three parties (A, B, C) a dental
situation and fixture application are simulated on a computer
screen by the first party. The second party produces first
components in connection with the prosthetic installation with the
aid of a recording and said simulation. Second components are
supplied by the third party (C) and the prosthetic installation is
assembled and fitted by the first party by means of said first and
second components. The recording includes first and second readings
of a loose prosthesis and a portion supporting the prosthetic
insallation. The simulation includes collation of representations
of the readings on a computer screen. Simulated fixture
applications are constructed and a model is produced by one of said
parties, or a fourth party. An assembly template guides
hole-forming members in an actual substrate in directions which
correspond to the directions of the fixtures. A dental bridge is
provided with attachment holes which connect to the holes formed in
the substrate. Fixtures are applied in said formed holes by the
first party and the dental bridge is secured in or on said
fixtures. The invention also relates to a computer program in
connection with the above.
Inventors: |
Andersson, Matts; (Lerum,
SE) ; Brajnovic, Izidor; (Goteborg, SE) |
Correspondence
Address: |
SWIDLER BERLIN SHEREFF FRIEDMAN, LLP
3000 K STREET, NW
BOX IP
WASHINGTON
DC
20007
US
|
Family ID: |
20282459 |
Appl. No.: |
10/451535 |
Filed: |
June 24, 2003 |
PCT Filed: |
December 27, 2001 |
PCT NO: |
PCT/SE01/02898 |
Current U.S.
Class: |
433/215 ;
705/301 |
Current CPC
Class: |
A61C 1/084 20130101;
B33Y 80/00 20141201; G06Q 10/103 20130101; A61C 13/0004 20130101;
A61C 13/26 20130101 |
Class at
Publication: |
705/001 |
International
Class: |
G06F 017/60 |
Foreign Application Data
Date |
Code |
Application Number |
Dec 29, 2000 |
SE |
0004884-3 |
Claims
1. A method for allocating prosthetic installation work between at
least three parties (A, B, C), where a dental situation and fixture
applications therein are simulated on a computer screen by the
first party (A), first components in connection with the prosthetic
installation are produced by the second party (B) with the aid of a
recording and said simulation, second components are supplied by
the third party (C), and the prosthetic installation is assembled
and fitted by the first party by means of said first and second
components, characterized in that the recording includes a first
reading of an impression or prosthesis (tooth structure) and a
second reading of a portion (all or part of a jaw) supporting the
prosthetic installation, in that the simulation includes collation
of images or representations (12) on the computer screen, which
images or representations (12) result from the first and second
readings and on the basis of which the simulated fixture
applications are constructed, in that the simulated fixture
applications include chosen positionings in relation to said
supporting portion, in that a model, e.g. of plastic, is produced,
preferably by a stereolithography method, by one of said parties,
or a fourth party, in that the first components include an assembly
template (88) which can be applied to said substrate and is
produced by means of the model and is intended for hole-forming
members which are guided by the assembly template in the substrate
in directions which correspond to the directions of the chosen
positionings, in that the first components include a unit forming
part of the installation, e.g. a dental bridge (85), which is
provided with attachment holes which connect to the holes formed in
the substrate, in that the second components include the fixtures
which are applied in said formed holes by the first party, and in
that the second components also include securing members (securing
screws) for securing the unit in said applied fixtures.
2. The method as claimed in patent claim 1, characterized in that
the model is constructed, preferably by the third party (C), in two
parts, where the first part represents the supporting portion (jaw
bone)and the second part represents the tooth prosthesis/tooth
structure, the first parts being separated from each. other by an
intermediate space to permit application in an articulator.
3. The method as claimed in patent claim 1 or 2, characterized in
that the first party sends order descriptions by means of
completely or partially automated equipment to the second party who
receives the order via completely or partially automated receiving
equipment.
4. The method as claimed in any of the preceding patent claims,
characterized in that the dental bridge is produced on the plastic
model, and in that spacers are mounted on the fixtures (87) of the
model and cementing sleeves (93) are placed on the spacers, and in
that the frame of the dental bridge is preferably made of carbon
fiber-reinforced plastic, titanium or a dental alloy.
5. The method as claimed in any of the preceding patent claims,
characterized in that the soft-tissue replacement (84) between the
first and second parts is made of soft plastic, e.g. vinyl or
polysiloxane, and in that the lengths of the spacers (93) are
secured to, and the configuration of the bridge is adapted to, the
soft tissue.
6. An arrangement for allocating prosthetic installation work
between at least three parties (A, B, C), and comprising a computer
(75) which is located with the first party and which is intended to
simulate, on its screen, a dental situation and fixture
applications therein, a first production unit which is located with
the second party and which is intended to permit production of
first components intended for the prosthetic installation with the
aid of a recording and said simulation, a second production or
supply unit which is located with the third party (C) and which is
used to produce second components, and first equipment which is
located with the first party and is intended to allow the
prosthetic installation to be constructed and fitted on the patient
with the aid of the first and second components, characterized in
that the recording includes a first reading of an impression or
prosthesis (tooth structure) and a second reading of a portion (all
or part of a jaw) supporting the prosthetic installation, in that
the computer (its program) is intended, in connection with the
simulation, to permit collation of images or representations on the
computer screen, which images or representations result from the
first and second readings, and to indicate on these the simulated
fixture applications which include chosen positionings in relation
to said supporting portion, in that second equipment, preferably a
stereolithography appliance, which is located with one of the
parties, or with a fourth party, is intended for production of a
model, e.g. of plastic, in that the first production apparatus is
provided for production of an assembly template which has been
constructed by means of the model and which has guide elements for
hole-forming members which can be guided by the assembly template
in order to assume directions which correspond to the directions of
the chosen positionings, in that the first production apparatus is
also provided for production of a structural unit, e.g. a dental
bridge, which forms part of the installation and which is provided
with attachment holes which connect to the holes formed in the
substrate, in that the second production or supply unit produces or
supplies the fixtures intended for said formed holes, and also
securing members (screws) for securing the structural unit in the
fixtures which are applied in the substrate.
7. The arrangement as claimed in patent claim 6, characterized in
that the model, e.g. the plastic model, consists of two parts,
where the first part simulates the supporting portion (patient's
jaw) and the second part simulates the impression/.
prosthesis/tooth structure, and in that between the parts there is
an intermediate space which corresponds to the site for soft
tissue, which intermediate space permits fitting/impaction in an
articulator (or re-mounting block) of an opposite jaw.
8. The arrangement as claimed in patent claims 6 or 7,
characterized in that the tooth structure (95) comprises wax with
prosthetic teeth made of acrylate and is tested on the patient.
9. The arrangement as claimed in any of patent claims 6 to 8,
characterized in that the first party (surgeon, prosthetist) uses
completely or partially automated ordering equipment, which for
example includes an order telephone, telecommunications network or
computer network (Internet), etc., to send an order to the second
party concerning the planned therapy, individual characteristics,
date, cost, etc., and in that the second party has access to
completely or partially automated receiving equipment.
10. The arrangement as claimed in any of patent claims 6 to 9,
characterized in that the recording includes information on the
relationship of the jaw bites to each other, and in that the
information to the second party includes details of the
articulator/articulators, the information preferably being able to
be transmitted to the second party by electronic means.
11. The arrangement as claimed in any of patent claims 6 to 10,
characterized in that the model which can be produced by the first
party, for example by means of X-ray tomography, can be transmitted
to the second party or the third party by completely or partially
electronic means, e.g. via computer and/or telecommunication
systems (including the Internet), and in that the third party, e.g.
with the aid of the first production unit, constructs a real
(actual) model which is sent to the first party or the second
party.
12. The arrangement as claimed in patent claim 11, characterized in
that the first part is supported on the second part with the aid of
small pin-shaped or spike-shaped elements which are automatically
simulated in a computer program for stereolithography
production.
13. The arrangement as claimed in patent claim 11 or 12,
characterized in that the model is provided with fixtures placed in
holes or seats in the model, and in that the assembly template is
adapted to said fixtures/holes/seats.
14. The arrangement as claimed in any of patent claims 6 to 13,
characterized in that the assembly template comprises spacers which
support hole-forming sleeves or drill sleeves, in that the spacers
are held together with the aid of carbon fiber-reinforced plastic,
and in that the template is assigned a contact with the second
model part which corresponds to the patient's jaw bone, the
template being able to be placed in a corresponding position in the
patient's mouth.
15. The arrangement as claimed in any of patent claims 6 to 14,
characterized in that the dental bridge comprises spacers which can
be mounted on the fixtures of the model, and in that cementing
sleeves are arranged on the spacers, and the frame (skeleton) of
the dental bridge consists of carbon fiber-reinforced plastic,
titanium or some other dental alloy.
16. The arrangement as claimed in any of patent claims 6 to 15,
characterized in that the soft tissue replacement (84) in said
intermediate spaces (86) is made of soft plastic (vinyl,
polysiloxane).
17. The arrangement as claimed in any of patent claims 6 to 16,
characterized in that the spacers comprise titanium and are
intended to be cemented on the titanium sleeves in the bridge in
the patient's mouth and to be screwed to the fixtures with spacer
screws made of gold.
18. The arrangement as claimed in any of the preceding patent
claims, characterized in that the second components comprise
assembly templates for drills/fixtures RP, drill guides, guide
drills and other types of drills, recessing members, fixtures,
assembly spacers, screw tighteners, supports, guide pins, mandrels,
toothbrushes, cement compositions, milling devices and machines for
bite grinding and hole-blocking means, which second components are
arranged in different platforms with different dimensions.
19. The arrangement as claimed in any of patent claims 6 to 17,
characterized in that the first apparatus is designed to permit,
upon transfer of the first and second components, a short time for
fitting the installation on the patient of 1 to 4 hours, preferably
11/2 to 2 hours.
20. A method for replacing, in a short application time, for
example about 1 to 3 hours, a loose prosthesis with a fixed
installation in a completely or partially edentulous patient,
characterized in that a) control, for example including primary
X-ray, of the status of the jaw bone by the first party (e.g.
dentist, dental specialist, prosthetist, etc.), b) in the event of
an acceptable status, X-ray tomography carried out by the surgeon
or carried out by the first party, c) input of a simulated first
representation of the X-ray tomography in the computer equipment
located at the first party, d) input of a simulated second
representation of the scanning or reading of the loose prosthesis
in said computer equipment located at the first party, e)
collation, in the computer equipment, of the simulated first and
second representations and placing of virtual fixtures by the first
party, f) transfer, preferably via the telecommunications and/or
computer network, for example the Internet, to a second party
(producer of dental base elements and structural parts) of computer
information relating to the first and second representations,
collation and the virtual fixtures, g) production as a function of
the transmitted and thereby received information, and preferably
with the aid of stereolithography, of an actual model, preferably
made of plastic, of the first and second representations by the
second party, in which the actual model element, for example the
tubular element, extends and is placed in positions and directions
which correspond to the positions and directions of the virtual
fixtures, h) transfer to the third party (dental technician) of the
actual model, i) transfer to the third party, preferably from the
first party, of a loose prosthesis model, preferably of wax,
together with a jaw model of the opposite jaw, preferably made of
plaster, and bite register index, j) use, by the third party, of an
articulator in order, by means of said loose prosthesis and jaw
models and bite register index, to determine the patient's bite,
taking into consideration the soft tissue space between jaw bone
and teeth, k) production, by the third party, with the aid of the
jaw model, of an assembly template with defined application
position against the jaw model and thus against the patient's jaw,
and with identified directions and positions for fixture dummies
and thus for the planned recesses in the patient's jaw bone, l)
production, by the third party, of a dental bridge by means of the
jaw model, and m) transfer of the assembly template and dental
bridge to the first party who, by means of the assembly template,
forms holes for planned insertion of fixtures and, after insertion
of the fixtures in the holes, anchors the dental bridge to the
fixtures thus inserted.
21. An arrangement for applying fixed installations in the form of
dental bridges in patients who are entirely or partly edentulous in
one jaw bone, preferably the upper jaw bone, and including first
units with the task of determining measures in different patient
cases, dealing with the production of computerized representations
with fixture applications placed in the different cases, producing
models of the desired installations and opposite jaw bone, ordering
productions of dental bridges and fixtures and securing members for
securing the dental bridges in the fixtures, and applying the
fixtures and securing the dental bridges in the jaw bones of the
patients, second units (dental technicians) who, with the aid of
information relating to the computerized representations and the
working models, deal with the production of templates for forming
the fixture holes on the patients and dental bridges for the
patients, and a third unit which receives from the first units via
ordering and distribution channels, preferably comprising
telecommunications and/or computer links, the order for fixtures
and accessories which are necessary for carrying out the various
order cases for the different patients, characterized in that the
third unit (supplier of basic elements and structural parts)
delivers basic sets of elements (fixtures, securing screws, tools,
etc.) to the first units (dentists, dental specialists,
prosthetists, etc.) as a function of first orders, which basic sets
cover the different variations arising in the particular types of
dental situations (application of dental bridges on entirely or
partially edentulous patients), and in that the third unit, as a
function of second orders, supplies additional sets of elements
which relate to the basic sets and which permit treatment of
differences in the patients' jaw bone status and jaw bone
sizes.
22. The arrangement as claimed in patent claim 21, characterized in
that the productions are based on X-ray tomography.
23. The arrangement as claimed in patent claim 21 or 22,
characterized in that the first units order, from the third unit,
models which are produced by stereolithography and which the third
unit supplies to the first or second units, and in that the second
units produce the dental bridges using the last-mentioned
models.
24. An arrangement for allowing a first party (surgeon,
prosthetist, etc.) to apply, within a short time, for example ca. 1
to 4 hours, preferably ca. 11/2 to 2 hours, a prosthetic
installation by means of structural parts (dental crowns, dental
bridges, etc.) supplied from a second party (dental technician) and
components (implants, spacers, securing screws) supplied from a
third party (producer of basic elements and structural parts), and
in which the structural parts are extracted from production parts
(models, templates, impressions, readings, tools, etc.) and, for
complete or partial production of the production parts, equipment
which at least the third party owns or has available, characterized
in that the third party's equipment is intended to operate with an
ordering function where the equipment receives information via a
telecommunications and/or computer link, e.g. consisting of or
comprising the Internet, said information concerning a dental
situation simulated on computer by the first party with the jaw
bone structure, the model of the installation applied to the
latter, and fixtures (implants) applied in the jaw-bone structure
and belonging to said components, and in that the third party's
equipment is intended to operate with stereolithographic production
of an actual model, for example made of plastic, of said simulated
jaw-bone structure and the simulated model, which actual model is
included in said production parts.
25. An arrangement for allowing a first party (surgeon,
prosthetist, etc.) to apply, within a short time, for example ca. 1
to 4 hours, preferably ca. 11/2 to 2 hours, a prosthetic
installation by means of structural parts (dental crowns, dental
bridges, etc.) supplied from a second party (dental technician) and
components (implants, spacers, securing screws) supplied from a
third party (producer of basic elements and structural parts), and
in which the structural parts are extracted from production parts
(models, templates, impressions, readings, tools, etc.) and, for
complete or partial production of the production parts, equipment
which at least the third party owns or has available, characterized
in that the third party's equipment is intended to operate with an
ordering function where the equipment receives information via a
telecommunications and/or computer link, e.g. consisting of or
comprising the Internet, said information concerning a dental
situation simulated on computer by the first party, with the
jaw-bone structure, and fixtures (implants) applied in the jaw-bone
structure and belonging to said components, and a model of the
installation, and in that the third party's components and any
production parts are arranged in platforms which are adapted in
dimensions to different sizes in different dental situations
(greater or lesser widths, heights, etc. of the particular jaw bone
and installations).
26. An arrangement for securing a dental installation with
considerable precision requirements in a patient's jaw bone by
means of fixtures and securing members, and comprising first
equipment for imaging the jaw bone and any prosthesis, second
equipment for reproducing a representation of the jaw bone and the
possible prosthesis in computer equipment, said computer equipment
being designed to permit virtual fixture application in the
representation, third equipment for producing an installation part
based on the representation, and fourth equipment for producing
working models by means of which attachments can be effected on the
installation part and the latter can be finished, characterized in
that the arrangement, preferably the fourth equipment, is designed
to produce hole-forming templates which can be applied with
precision to the jaw bone, and in that the items of equipment
operate with an accuracy which satisfies said considerable
precision requirements and eliminates the need for carrying out
sample trials on the patient between the imaging and the hole
formation, all this with the aim of achieving a short time, for
example 1 to 4 hours, for securing the installation in place.
27. An arrangement permitting a responding party to supply an
inquiring party or parties with information or details concerning a
prosthetic installation and work related to the latter, in which a
computer is designed to simulate a dental situation and. fixture
application therein, and one or more production units are designed
to produce components intended for the prosthetic installation and
for inserting the same, and each inquiring party has equipment
permitting or preparing for the prosthetic installation,
characterized in that a data-processing arrangement contains or
receives data or information relating to selected parameters of
prosthetic installations previously produced in the practice, in
that the data-processing arrangement is designed to receive and
compare one or preferably several parameters of the current
prosthetic installation with a corresponding parameter or
corresponding parameters of said selected parameters, and in that
said information represents the result of the particular
comparison.
28. The arrangement as claimed in patent claim 27, characterized in
that the information can be related to one or more characteristics
of the prosthetic installation, for example its strength, esthetic
appearance and/or color.
29. The arrangement as claimed in patent claims 27 or 28,
characterized in that the information consists of or comprises
details and/or data concerning whether the prosthetic installation
conceived of by the inquiring party and/or the work on this
installation is within or outside the boundaries of what is known
to be acceptable in practice.
30. An arrangement for effecting the supply of components
(products) for prosthetic installations and the design of these
from the producing party to the party which ordered the components
(or the products), where said supply is based on the handling of
orders, finances, invoices, the components (the products) and
ordering parties (customers), where ordering and production
functions (equipment) for the components are located at or
available to the ordering party, characterized in that between the
ordering and production functions (equipment) there is a storage
arrangement for said handling, in that the storage arrangement is
of modular design with a substantially identical or corresponding
structure for each module, and in that the modules can be expanded
or reduced as the number of customers increases or reduces and/or
changes character.
31. A program stored on a computer medium, for example on a
diskette, CD, etc., for generating a protocol with the aid of one
or more computers in the production, fitting and/or monitoring of
the production or fitting of dental prosthetic installations, where
a party (unit) supplies components (products) for prosthetic
installations and the design (implementation) of these, and where
ordering parties (units) who ordered said components (products)
prepare and insert the prosthetic installations, characterized by
a) definition of patient and his/her tooth and/or jaw bone status,
b) definition of work procedure for the patient based on production
and comparison with stored data relating to similar or
corresponding installations, c) definition of the advantages with
the current prosthetic installation, d) definition for production
of models, for example drill model, e) definition of X-ray
tomography, f) definition of two-dimensional or three-dimensional
CADD equipment, g) definition of model production by means of
stereolithography, h) definition of model production by dental
technicians, and i) definition of preparations by surgeon.
32. The program as claimed in patent claim 31, characterized in
that one or more of the following steps are carried out in parallel
with points a) to i): j) definition of variables, k) definition of
documents, l) definition of forms, m) possible definition of
folders and/or n) definition of envelopes.
Description
[0001] The present invention relates to a method for allocating
prosthetic installation work between at least three parties, where
a dental situation and fixture applications therein are simulated
on a computer screen (in computer equipment) by the first party,
first components in connection with the prosthetic installation are
produced by the second party with the aid of a recording and said
simulation, second components are supplied by the third party, and
the prosthetic installation is assembled and fitted by the first
party by means of said first and second components. The invention
also relates to an arrangement connected with this method.
[0002] The invention also concerns a method for replacing, in a
short application time, a loose prosthesis with a fixed
installation in a completely or partially edentulous patient. A
short application time is understood, for example, to be a time of
1 to 4 hours, for example ca. 11/2 to 2 hours. The arrangement is
intended for applying fixed installations, for example in the form
of dental bridges, in patients who are completely or partially
edentulous, at least in one jaw bone, preferably the upper jaw
bone. The arrangement can comprise first units (or items of
equipment) with the task of determining measures in the various
patient cases, dealing with the production of computerized
representations with fitted fixture applications in the various
cases, producing working models of the desired installations and
opposite jaw bone, ordering the production of dental bridges and
fixtures and securing members for securing the dental bridges, and
effecting the application of the fixtures and the securing of the
installations or dental bridges in the patients' jaw bones. Said
first units or items of equipment are related to dentists, dental
specialists, prosthetists, surgeons, clinics or hospitals for X-ray
tomography, etc. Second units or items of equipment which represent
or are located at dental technicians or the like use information
relating to the computerized representations and the working models
to produce templates for forming fixture holes on the patients and
the patients' dental bridges. A third unit or item of equipment
which represents a supplier of basic elements and/or structural
parts (cf. PROCERA) receives from the first units or items of
equipment, via ordering and distribution channels, the order for
fixtures and accessories which are necessary for executing the
various orders for different patients. The ordering and
distribution channels can comprise or consist of telecommunication
and/or computer links, it being possible for the Internet to form
or be part of one or more links. The arrangement can thus permit,
within said short time, the application of a prosthetic
installation by means of structural parts, dental crowns, dental
bridges, etc., received from a second party who can include said
dental technicians, and components, for example implants, spacers,
securing screws, etc., received from a third party, who can be a
producer of basic elements and structural parts. The structural
parts can be extracted with production parts which can consist of
models, templates, impressions, readings, tools, etc., and
equipment or items of equipment for complete or partial production
of the production parts, which equipment or items of equipment are
owned by or available to at least the third party, which signifies
that in an alternative embodiment the third party is able in turn
to arrange the production to be done by a further party specialized
in the particular production part or production parts. The
arrangement can thus permit, with considerable precision
requirements, the securing of a particular dental installation in a
jaw bone or other bone of a patient by means of fixtures and
securing members. The arrangement can in this case comprise or
operate with first equipment for imaging the jaw bone and possible
prosthesis, second equipment for reproducing representations of the
jaw bone and possible prosthesis in computer equipment, said
computer equipment being intended to permit virtual or planned
fixture application in the representation. The arrangement also
comprises or operates with third equipment for producing an
installation part based on the representation, and fourth equipment
for producing working models, by means of which attachments can be
made on the installation part and the latter can be finished. The
invention also relates to an arrangement which permits a responding
party to supply to an inquiring party or parties information which
may concern the prosthetic installation and the work associated
with the latter. A computer is in this case designed to simulate a
dental situation and fixture applications therein. One or more
production units are arranged to produce components intended for
the prosthetic installation and for fitting the latter, and
equipment located at the respective inquiring party is designed to
permit or prepare the prosthetic installation. In addition, the
arrangement is intended to permit the supply of components or
products for prosthetic installations and the design of these from
the producing party to the party ordering the components. The
supply is in this case based on the handling of orders, finances,
invoices, the components or the products and the ordering parties,
i.e. the customers. The invention also proposes a program stored on
a computer medium for generating a protocol with the aid of one or
more computers for production, fitting and/or monitoring of the
production and fitting of dental prosthetic installations. One
party or unit in this case supplies components or products for the
prosthetic installations and the designs of these. The parties or
units ordering said components or products prepare and install the
prosthetic installations.
[0003] In connection with installations of this type, it is already
known to use X-ray tomography and other imaging principles in order
to exactly determine the respective dental situation of the
patient. It is known to use computer equipment located with a
dentist, prosthetist, dental experts, etc. and to input into the
computer equipment representations from the radiography and
impression results and to virtually adapt and apply fixtures in
connection with said representations. Reading apparatus, for
example for reading off a loose prosthesis or the like, are known
per se. The apparatus can work according to different principles,
for example laser scanning principles, photo principles, etc. It is
also already known to use production functions for a dental or
other body-related model with the aid of stereolithography.
[0004] Reference is made in purely general terms to "Computer
Technology", published by Jos Vander Sloten ???? 2000. Reference is
made in particular to the section "An image-guided planning system
for endosseous oral implants" by Kris Verstreken et al., pages
192-240.
[0005] Reference is also made in purely general terms to Handboek
Orale Implantaten 1999, Bohn, Stafleu.
[0006] Reference is also made to various lecture programmes and
courses arranged by ??? prior to May 2000.
[0007] Reference is also made to the PROCERA SE production system
which concerns computerized and automated production of basic
elements, models, tooth replacements (e.g. sleeves, dental crowns,
etc.). Reference is made in this connection to the patents and
patent applications WO 98/44865 and ???? owned by Nobel Biocare AB,
Sweden. Reference is also made to Swedish Patent SE 457,691 with
the same owner and relating to the production of dental products by
means of carbon fiber-reinforced plastic. Reference is also made to
the Swedish applications filed by the same Applicant as the present
application, namely "Device for determining position", "Method and
device for a dental unit or unit intended for the human body", and
"Device for forming holes and inserting sleeves in a unit included
in a dental attachment part".
[0008] Reference is also made to the range of products commercially
available from Nobel Biocare AB, Sweden, namely sleeves, dental
bridges, fixtures, securing members, tools, apparatus, instruments,
etc.
[0009] It is already known to design a fixed installation for a
patient who is completely or partially edentulous and wishes to
have an installation fitted, for example instead of an already
existing prosthesis. The installation work in question has been
extremely time-consuming and has involved a number of trials on the
patient covering a long period of time which has extended over
weeks and months. The patient has found such treatments
inconvenient and for this reason has been unwilling to accept or
has completely refused to undergo the treatment in question. There
is now a general need to reduce the actual treatment time for the
patient. The present invention deals with this problem and proposes
that the actual insertion or implantation of the fixed installation
must be able to be carried out in an extremely short time, for
example in one day or part of a day.
[0010] The present invention is based on the recognition that the
precise fitting work which was previously carried out on the
patient can be undertaken outside the patient by means of the
exactness or precision being built into, on the one hand, the
equipment used by the parties involved (the units, equipment) for
the different parts of the installation, and on the other hand into
the production of models with the aid of apparatus/tools, and also
into the basic elements for the structural parts, and the
structural parts themselves. The invention solves this problem
too.
[0011] In connection with the production of the installations and
the fitting of the installations, there are considerable cost
restraints on the parties who are concerned with the production and
the installation of the tooth replacements in question (e.g. dental
crowns). A problem which the invention solves in this connection is
that of providing a way of allocating the finances provided for in
each individual case between the different parties. It is important
that the allocation of work and the routines surrounding the
handling between the parties are so efficient that the economic
target can be fulfilled despite the considerable precision
requirements imposed on the installations in question. The
invention also solves this problem and proposes production
principles, work allocation principles and advantageous debiting
principles for said installations. Among other things, the third
party (who in some of the subsequent arrangements of the parties
has also been referred to as the second party in the chain, and
this for technical reasons) must be able to ensure efficient and
accurate distribution and debiting of the basic elements, parts and
services involved. The second party (who for technical reasons can
also be referred to as the third party in certain cooperation
formats) must be able to perform his part of the work and satisfy
the precision requirements which have been set. The first party
must, as previously, be responsible for diagnostics and produce
images and models of the patient and carry out the final
installation work in a very short time. The debiting and mutual
allocation of the resources provided must in this case be able to
be done in accordance with what is proposed by the invention.
[0012] It is important that apparatus and methods and elements
which are known per se and well proven can be used for the
production of the installations and fitting of the installations in
question. The invention also solves this problem and is based on
known techniques and known methods being able to be used as far as
possible.
[0013] It is known that a large number of dental crowns and dental
bridges, for example ceramic crowns or dental bridges (AC crowns;
AllcerAM) have been produced and fitted during the last ten years.
These have been produced by, among others, Nobel Biocare,
Gothenburg, Sweden. The system known as the PROCERA CAD/CAN system
has been used, in which a detailed recording of, inter alia,
preparation surfaces has been stored in digital form as complete
data files combined with identification of tooth type and orders
via the computer network. These data files permit visualization of
each preparation on a computer screen, and the two-dimensional
profiles thus obtained have been used in earlier studies in order
to obtain an overview of the various structures on the
preparations. In this respect, it has been found that there is a
great variation between different groups of dentists. It is
therefore possible to further refine the recommendations for the
installation work and the structures on the installations. The
invention also solves this problem.
[0014] The features which can principally be regarded as
characterizing a method according to the invention are that the
recording includes a first reading of an impression or prosthesis
(tooth structure) and a second reading of a portion (all or part of
a jaw) supporting the prosthetic installation, that the simulation
includes collation of images or representations on the computer
screen, which images or representations result from the first and
second readings and on the basis of which the simulated fixture
applications are constructed, and that the simulated fixture
applications include chosen positionings in relation to said
supporting portion. The method is further characterized by the fact
that a model, for example made of plastic, is produced, preferably
by a stereolithography method, by one of said parties, or a fourth
party, and that the first components include an assembly template
which can be applied to said substrate and is produced by means of
the model and is intended for hole-forming members which are guided
by the assembly template in the substrate in directions which
correspond to the directions of the chosen positionings. Finally,
the method can be considered as being characterized by the fact
that the first components include a unit forming part of the
installation, for example a dental crown, which is provided with
attachment holes which connect to the holes formed in the
substrate, that the second components include the fixtures which
are applied in said formed holes by the first party, and that the
second components also include securing members, for example
securing screws, for securing the unit in said applied
fixtures.
[0015] Further developments of the method are set out in the
attached dependent claims concerning said method.
[0016] The features which characterize an arrangement according to
the invention are, inter alia, that the recording includes a first
reading of an impression or prosthesis (tooth structure) and a
second reading of a portion (all or part of a jaw) supporting the
prosthetic installation, that the computer (i.e. its program) is
intended, in connection with the simulation, to permit collation of
images or representations on the computer screen, which images or
representations result from the first and second readings, and to
indicate on these the simulated fixture applications which include
chosen positionings in relation to said supporting portion, and
that second equipment, preferably stereolithography equipment,
which is located with one of the parties, or with a fourth party,
is intended for production of a model, for example of plastic.
Further characteristics are that the first production unit is
provided for production of an assembly template which has been
constructed by means of the model and which has guide elements for
hole-forming members which can be guided by the assembly template
in order to assume directions which correspond to the directions of
the chosen positionings, and that the first production unit is also
provided for production of a structural unit or structural part,
for example a dental crown, which forms part of the installation
and which is provided with attachment holes which connect to the
holes formed in the substrate. Further characteristics are that the
second production or supply unit produces or supplies the fixtures
intended for said formed holes, and also securing members (for
example, screws) for securing the structural unit in the fixtures
which are applied in the substrate. Further developments of the
novel arrangement are set out in the dependent claims concerning
said arrangement.
[0017] The invention relates to different method steps, where a
first step includes control, for example primary radiography, of
the jaw-bone status by the first party who in this case can be a
dentist, dental specialist, prosthetist, etc. If the status is
acceptable, X-ray tomography is performed by a surgeon, hospital,
clinic, who or which have access to the radiography equipment in
question. A simulated first representation of the X-ray tomography
is input into the computer equipment, preferably by the first
party. A simulated second representation of a scanning or reading
of a loose prosthesis is additionally input into said computer
equipment, which scanning or reading can be carried out by the
first party or second party. The first and second representations
are coordinated in the computer equipment, in connection with which
virtual fixtures are placed in position by the first party, who in
this case can be a dentist, prosthetist, dental expert, etc. The
result thus obtained is transferred, preferably via the
telecommunications and/or computer network, which can include the
Internet, to a second party who in this case is a producer of
dental basic elements and structural parts (cf. PROCERA) in the
form of computer information or digital information which can be
related to the first and second representations, said coordination
and said virtual fixtures. Thereafter, production of the actual
model is carried out on the basis of the information thus
transferred and thus received, and preferably with the aid of
stereolithography, which model can be a plastic model of the first
and second representations, this being done by the second party who
owns or has access to stereolithography equipment. Elements are
introduced into the actual model, for example tubular elements
which extend and are placed in positions and directions
corresponding to the positions and directions for the virtual
fixtures. The actual model is thereafter transferred to a third
party who in this case is a dental technician or the dental
laboratory. A loose prosthesis model, preferably made of wax, is
also transferred to the third party, preferably from the first
party, together with a jaw model of the opposite jaw, which
last-mentioned model can be made of plaster. In addition, a bite
register index is transferred to the third party, i.e. the dental
technician. The third party (the dental technician) uses an
articulator in order to produce the patient's bite configuration by
means of said loose prosthesis and jaw models and bite register
index, taking into consideration the soft-tissue space between jaw
bone and teeth. The third part (the dental technician) uses the jaw
model to produce an assembly template with a defined position of
application to or in relation to the jaw model and thus in relation
to the patient's jaw and with identified directions and positions
for fixture dummies and thereby for the planned recesses in the
patient's jaw bone. Production by the third party (dental
technician) of a tooth replacement, for example the dental bridge,
by means of the jaw model, and finally the assembly template and
the produced tooth replacement or dental bridge are transferred to
the first party (dentist, prosthetist, surgeon, etc.) who, by means
of the assembly template, forms holes for the planned fixture
insertions and, after insertion of the fixtures in the holes,
anchors the dental bridge to the fixtures thus inserted.
[0018] Another characteristic is that the supplier of basic
elements and structural parts (called the third unit in another
related case) supplies basic sets of elements, which can consist of
fixtures, securing screws, tools, etc., to the first units which
are dentists, dental specialists, prosthetists, etc., as a function
of first orders. The basic sets can in this case cover the
different variations which can arise in the particular dental
situations which can consist of applying dental bridges to
completely or partially edentulous patients. On the basis of second
orders, the last-mentioned supplier of basic elements and
structural parts (PROCERA) supplies accessory elements belonging to
the basic sets, which accessory elements make it possible to deal
with differences in the jaw-bone status and jaw-bone sizes of
patients. In other words, as is known per se, the patients have jaw
bones of different sizes and structures and for this reason said
accessory elements to the basic set are required in order to permit
effective treatment by the dentist, prosthetist or the like.
[0019] The producer of basic elements and structural parts
(PROCERA) or the third party owns, or has available to it,
equipment designed to operate with an ordering function in which
the equipment receives, via a telecommunications and/or computer
link, for example including the Internet in accordance with the
above, information relating to a dental situation with jawbone
structure simulated on computer by the first party, a model of the
installation applied to this, and fixtures (implants) applied in
the jaw-bone structure and belonging to the abovementioned
components, and in addition the equipment belonging to the producer
of basic elements and structural parts is designed to operate with
stereolithographic production of an actual model, for example made
of plastic, of said simulated jaw-bone structure and simulated
model, which actual model is included in said production parts.
[0020] The components and optional production parts held by the
third party (producer of basic elements and structural parts) can
in this case be arranged in platforms which are adapted in
dimensions to different sizes in different dental situations (i.e.
greater or lesser widths, heights, etc., of the jaw bone and
installations in question). Thus, treatment arrays for different
situations can be offered. The basic arrays can be presented in
different platform situations, where a first platform relates to
the dimensions "wide", "regular" and "narrow", which thus relate to
the jaw-bone structures.
[0021] The invention can also relate to an arrangement with
different items of equipment, in which first equipment is designed
for imaging the jaw bone and any prosthesis, second equipment for
reproducing a representation of the jaw bone and the possible
prosthesis in the computer equipment, said computer equipment being
designed to permit virtual fixture application in the
representation, third equipment for producing an installation part
based on the representation, and fourth equipment for producing
working models by means of which attachments can be effected on the
installation part and the latter can be finished. The arrangement
in question, preferably the fourth equipment, is designed to
produce hole-forming templates which can be applied with precision
to the jaw bone, and the items of equipment operate with an
accuracy which satisfies said considerable precision requirements
and eliminates the need for carrying out sample trials on the
patient between the stages of imaging and hole formation, all this
with the aim of achieving a short time for securing the
installation, which short time can be, for example, 1 to 3 hours,
during which holes are formed and fixtures applied and the
installation is secured in the implanted fixtures.
[0022] The invention is also characterized in that between the
abovementioned ordering and production functions (equipment) there
is a storage arrangement for likewise abovementioned handling. The
storage arrangement will be of modular design with a substantially
identical or corresponding structure for each module. The modules
can be expanded or reduced on the basis of the number of new
customers or departing customers. Alternatively, the customer
clientele may change character and/or be redistributed.
[0023] The invention also relates to the fact that a
data-processing arrangement can contain or receive data or
information relating to selected parameters of installations
previously produced in the practice. The data-processing
arrangement can be designed to receive and compare one or
preferably several parameters of the current prosthetic
installation with a corresponding parameter or corresponding
parameters of said selected parameters. Said information can
represent the result of the particular comparison and can, for
example, relate to one or more properties of the prosthetic
installation, for example strength, esthetic appearance and/or
color. In addition, the information can consist of or comprise
details and/or data to the effect that the prosthetic installation
conceived of by the inquiring party and/or the associated work on
this installation is within a risk zone and unacceptable.
[0024] The invention also refers to a program stored on a computer
medium for generating a protocol with the aid of one or more
computers in the production, fitting and/or monitoring of the
production and fitting of dental prosthetic installations, where a
party or unit supplies components or products for the prosthetic
installations and the design of these, and where ordering parties
or units who ordered said components or products prepare and insert
the prosthetic installations. The features which can principally be
regarded as characterizing the program are the stages comprising:
definition of patient and his/her tooth and/or jaw-bone status,
definition of work procedure for the patient based on production
and comparison with stored data relating to similar or
corresponding prosthetic installations; definition of the
advantages with the current prosthetic installation; definition of
models, for example drill model; definition of X-ray tomography;
definition of two-dimensional or three-dimensional CADD equipment;
definition of model production by means of stereolithography;
definition of model production by dental technicians; and
definition of preparations by surgeon. The definitions in question
take place in parallel with production of definitions of variables,
documents, forms, folders and/or envelopes.
[0025] By means of what has been proposed above, the work time on
patients is surprisingly shortened. After said short time, the
patient can already leave the dentist, prosthetist, surgeon, etc.,
with a fixed installation applied in his jaw. The fixed
installation can incorporate effectively without too much
inconvenience to the patient, who thereby avoids a protracted
process involving insertion of fixtures and tests being done on
these, which tests have hitherto comprised a number of trials. The
precision requirements can be built-in with the second and third
parties, i.e. the dental technician or the dental laboratory and
the supplier of the basic elements and structural sets (cf.
PROCERA). The already known range of basic elements and structural
parts can also continue to be used, and the invention affords the
dental technician or the dental laboratory a method and equipment
which simplify and shorten their work, while satisfying the
professional requirements. Existing debiting and distribution
channels can be used by the third party (PROCERA) which in this
respect has available to it or owns an advanced debiting and
distribution system. Some parts of the method and the equipment
operate with dental technology, and the information for X-ray,
scanning, imaging etc. can be transmitted digitally in a manner
known per se. The various digital representations of advanced X-ray
imaging, advanced models and structural parts (obtained by
stereolithography, for example) can be easily transferred via
existing links in the telecommunications and/or computer network.
Computer programs for producing the models in question with very
great precision are available on the market and can be used in this
context. Said exact models can be used as structural models by the
dental technician or the dental laboratory, which receives
guarantees of the required precision in connection with dental
installations. The invention also affords refined treatment methods
in connection with the production of models, templates, etc., and
also structural parts and installations which are to be used by the
dental technician, prosthetist, dental expert, surgeon, etc. In
accordance with the invention, algorithms can be developed for
calculation and computer. programming in order to collate and
handle different data parameters for example characterized by form
and installations of a large number of preparations. Thus, it is
possible to calculate a certain number of characteristic parameters
concerning the shape of the preparation, compare these with visual
characteristics for the preparations, establish the most frequent
differences from an ideal, and study possible geographically
related variations. It is possible to propose corrections in the
event of critical differences from ideal preparations and also to
indicate failures which occur upon insertion of the installation or
some time after the use of the installation by the patient. A
computer program can calculate variations of critical parameters in
each installation, which can mean that the useful life of future
installations may be extended.
[0026] A presently proposed embodiment of an arrangement and method
will be described below with reference to the attached drawings, in
which:
[0027] FIG. 1 is a basic circuit and block diagram showing the
patient and three parties involved in supplying a fixed
installation for the patient's' jaw bone, and the flow of
components, structural parts and basic elements between the
parties, and also the debiting functions connected with the
above,
[0028] FIG. 2 is a basic circuit and block diagram showing the
distribution and debiting paths for the parties involved,
[0029] FIG. 3 is a basic circuit and block diagram showing how a
large number of patients can turn to a large number of first
parties who in turn are served by a smaller number of dental
technicians or dental laboratories who in turn are served by a
third party (PROCERA),
[0030] FIG. 4 is a basic circuit and block diagram showing how the
parties A, B and C are interconnected with their computer equipment
via different types of links,
[0031] FIG. 5 is a vertical section and partial cutaway view
showing the production of a hole-forming template (assembly
template) using a model which images the jaw bone, and a fixture
dummy and expansion spacer and expansion screw applied in the
model,
[0032] FIG. 6 is a vertical view and partial cutaway view showing
parts of the dental installation applied on or in a jaw bone,
[0033] FIG. 7 is a basic circuit diagram showing the cooperation
between the parties or the units A, B and C,
[0034] FIG. 8 is a perspective and symbolic view showing the
commercial handling of installations and customers associated with
the installations,
[0035] FIG. 9 is a perspective view showing a module system for
handling according to FIG. 8, and
[0036] FIG. 10 shows a flow chart for a dental installation on a
patient.
[0037] In FIG. 1, a patient is symbolized by P and three parties by
A, B and C, a first party being a dentist, prosthetist, dental
expert, surgeon, etc., i.e. the party or subsidiary party dealing
with the diagnosis and actual installation work on the respective
patient. A second party B is represented by the dental technician
or the dental laboratory, and a third party C is a supplier of
basic elements and structural parts (cf. PROCERA). In the present
case, the third party has access to automated production of the
basic elements and structural parts in question. The equipment or
units located with the first party are symbolized by 1, the
equipment and units located with the second party are symbolized by
2, and the. equipment and units located with the third party are
symbolized by 3. At the first party A, the distribution between the
various functions, for example a dentistry function, prosthetic
function, dental expert function, surgical function, etc., is
utilized in a manner known per se by the patient P. The party A can
be considered as having access to X-ray functions at a hospital,
clinic or corresponding establishment 4. In the present case, the
third party C can own or have access (for example on a contract) to
stereolithography equipment 5 of a type known per se. The first
party A (i.e. the actual subsidiary party) first undertakes a
preliminary examination of a patient P in order to assess whether
he or she is in fact suitable or not for a fixed installation in a
given jaw bone. In the first instance, the patients are completely
or partially edentulous in the upper jaw, for which reason an
examination of this jaw is most often carried out. It is possible
per se to provide fixed installations in a lower jaw which is
missing one or more teeth. In a case where it is decided that the
patient is able to receive a fixed installation, the patient's jaw
or jaw part must be read off or scanned. In addition, imaging of
any loose prosthesis (tooth prosthesis) must be carried out. In the
present case, the imaging function is indicated in FIG. 1 by means
of arrows 6 and 7, where the first arrow represents the imaging of
the jaw or jaw part, and the arrow 7 represents the imaging of any
loose prosthesis. In cases where there is no loose prosthesis, a
model is produced which could be considered to correspond to the
loose prosthesis in question. In a case where the party A uses
X-ray tomography, the patient is sent to a radiography department
at a hospital 4 or the like if the first party A does not have such
X-ray equipment. This contact between the patient and the
radiography department is symbolized by 8 in FIG. 1. In a case
where the radiography. department at a hospital 4 or the like is
used, the result of the X-ray examination can be digitalized and
sent via a link 9 in digital form 10. Both the hospital 4 or the
like and the equipment or unit 1 at the first party A are in this
case provided with computer equipment 4a and 1a, respectively. The
transfer can be done by telecommunication and/or computer links in
a manner known per se.
[0038] In the case where a plastic model or a model made of other
material is to be produced by means of stereolithography, the party
A contacts or orders from the party C. A digital signal 11 is
transmitted by the party A to the party C who imports or receives
the signal 11 in computer equipment 3a. The transmission is made
via a link 12 in the direction of the arrow 13. The digital signal
11 represents representations of the patient's jaw bone and loose
prosthesis or equivalent. The signal 11 also represents a
coordination of the imaged jaw bone and the imaged loose prosthesis
and also fixture applications which have been made by the party A
in a manner known per se. The link 12 can be made via
telecommunication and/or computer links, which can include the
Internet. Here, the expression telecommunication and/or computer
links can be taken to mean the generally available links or special
links. The party C contacts a fourth party (not shown in FIG. 1) if
the third party C does not itself have the stereolithography
equipment in question. The fourth party in this case owns the
equipment in question, and the third party transfers information 12
concerning the order and information which corresponds to the
readings taken by the first party A. The information 14 is
digitalized and transmitted via telecommunication and/or computer
links in accordance with the above. The direction of the signal is
indicated in FIG. 1 by the arrow 15. The fourth party designs or
produces the stereolithographic wax model and sends the latter back
to the third party see the arrow 16. Debiting functions and
ordering functions take place via said link 17, and the debiting
functions known per se are in this case used at or by the party C.
The computer equipment located with the fourth party is indicated
by 5a. Information regarding the plastic model produced is sent
back if appropriate to the first party A in the direction of the
arrow 18. The stereolithographic actual model is transferred from
the party C to the party B, see arrow 19. The second party
receives, from the first party, orders to the effect that the model
in question is to be produced. This ordering can be done via the
telecommunication and/or computer network and has been symbolized
in FIG. 1 by the digital signal 20. In addition, information 21
concerning planned treatment, individual characteristics, date,
cost, etc. is transmitted to the second party B which has access to
computer equipment 2a. The first party A also orders from the third
party C basic arrays for the given patient type and possible
auxiliary arrays which are intended to meet special characteristics
of the patient. Said arrays comprise different types of basic
elements, for example drills/fixtures, drill guides, guide drills
and other types of drills, recessing members, fixtures, mounting
spacers, screw tighteners, supports, support pins, devices,
toothbrushes, cement sets, millers and machines for bite grinding
and means for blocking holes, etc. The ordering and debiting
functions are effected in the third party's known ordering and
debiting equipment. The ordering function is digitalized and is
represented by 22 in FIG. 1. The distribution path can also be
considered as part of the link 12 in the direction of the arrow 18.
Corresponding ordering, distribution and debiting channels are
established between the second party B and the third party C. The
ordering from the second party is digitalized, in the same way as
above, and takes place with digital signals 23 in the direction of
the arrow 24. Supplies and debiting functions from the party C to
the party B take place via the link 25 in the direction of the
arrow 19 by means of digital information 26 and a hardware
distribution channel which can be considered as forming part of, or
is symbolized by, the link 25.
[0039] The second party produces, as final products, first
components which are supplied to the first party via distribution
channel 27, indicated symbolically in FIG. 1, in the direction of
the arrow 28. Said first components comprise an assembly template
29 which the first party uses as a hole-forming member. Also
included is a unit forming the installation, for example a dental
crown 30. The third party supplies second components 31 in
accordance with the description given above and below.
[0040] The first party uses the assembly template for forming holes
in the patient's jaw and applies the fixtures which have been
obtained from the third party and are included in said second
components 31. In addition, the third party supplies, inter alia,
the abovementioned securing screws to the first party. The first
party can form holes, apply the fixtures and anchor the
installation or the dental crown to them in the abovementioned very
short time. In subsidiary equipment 32 located with the first party
B, use is made, inter alia, of an articulator of a type known per
se. A model, for example a plaster model 33, of the opposite jaw is
applied in the articulator, together with the actual model produced
by stereolithography, fixture dummies and said bite register index.
In this connection, soft plastic or the like is used to produce a
model of the gum which will lie between the jaw-bone model and the
loose prosthesis model, which is also produced by the first party.
The second party produces the dental bridge with the aid of the
stereolithographic plastic model, to which spacers are mounted on
fixtures of the model and cementing sleeves are secured on the
spacer. The frame of the dental bridge is preferably made of carbon
fiber-reinforced plastic, but can also be made of titanium or a
dental alloy. The soft-tissue replacement can be made of vinyl or
polysiloxane. The lengths of the spacers and the configuration of
the bridge with respect to soft tissues are determined and imaged.
Prosthetic teeth are applied on the structural part or bridge
skeleton thus formed. The tooth replacement or prosthetic teeth are
worked for example from a wax model in which the prosthetic teeth
are made of acrylate and have been tested on the patient. The soft
tissue can be provided with small pin-shaped or spike-shaped
elements which are automatically imaged in a computer program
during the stereolithographic production. Said assembly template
can comprise spacers which bear hole-forming sleeves or drill
sleeves and are held together with the aid of said carbon
fiber-reinforced plastic.
[0041] In FIG. 2, a number of patients are indicated by P, P', P",
P'". These patients are assumed to turn to party A who carries out
the abovementioned examination and modeling. The patients are
handled by means of first equipment 34 and the first party, in
accordance with the above, orders the basic sets 35, 36 and 37 and
any relevant auxiliary sets 38, 39 and 40 in order to meet the type
of dental treatment with its associated variations. The connections
of the patients to the first party are indicated by 41, 42, 43 and
44. The distribution channels from the third unit or party C to the
first unit or party A are indicated by 45, 46, 47, 48, 49 and 50.
Other components, for example structural parts, tools, instruments,
can also be ordered by party A from party C and are symbolized by
component content 51 and the distribution path 52. Thus, for
example, the wax model or a representation of the wax model can be
distributed on this path. The party B can also place orders with
the party C. Such orders can include models, tools, instruments,
etc., and are symbolized by the component content 53 and the
distribution paths 54 and 55, which for example can be parcel
delivery routes. In FIG. 2, debiting functions or debiting
equipment are indicated by 56 at the third party, by 57 at the
second party and by 58 at the first party. Said debiting channels
are established using coupled-up or fixed telecommunication and/or
computer links, which also serve as the abovementioned ordering and
data signal transfer channels. Thus, the party A can order
equipment or a model from party C via the link 59, which is
recorded by the party C and debited via the same or corresponding
link. The ordering direction is indicated by 60 and the debiting
direction and confirmation direction is indicated by 61. The party
B can also place orders with the party C, and this is done via a
link 62 in a direction indicated by 63. Debiting of the equipment
or service in question can take place via a corresponding link 62
in the direction 64. In a corresponding way, ordering and debiting
functions are exchanged between the units A and B via a link 65. A
parcel link or hardware link 66 is also arranged between these
units A and B in order to permit transfer of models from party A to
party B and finished installations, templates, etc., from party B
to party A. In FIG. 2, links 67 for the debiting of the patient by
the party A are also indicated symbolically. In the embodiment
according to FIG. 3, a large number of patients P are served by a
relatively large number of first parties (dentists, prosthetists,
etc.) . The first parties are served in turn by a number of dental
technicians or laboratories which are assumed to be present in a
smaller number than the number of first parties. A third unit C
(PROCERA) can serve the whole number of patients and first and
second units. In accordance with the above, the third unit supplies
said basic arrays 68a, 68b, 68c and auxiliary sets 68a', 68b' and
68c' belonging to these. Components, instruments, etc., are
symbolized by 69 and, in accordance with the above, can be supplied
to the second party B, see indicated arrows. The third party can
also offer a service, which has been indicated by 70, which service
can be oriented toward the patients and said first and second
parties. In FIG. 3, the principal debiting function is indicated by
71. In FIG. 3, the ordering functions received in the different
areas are also shown by 72, 73 and 74. The arrows shown in FIG. 3
indicate the directions of the services, components and debiting in
the system.
[0042] In FIG. 4, in a block circuit diagram, the computer
equipment located with the parties A, B and C is indicated by 75,
76 and 77, respectively. The computer equipment for the X-ray
function and for the stereolithography function is indicated by 78
and 79. The computer equipment is connected by modem, see for
example 75a and 76a on computer equipment 75 and 76, to different
networks. The electronic networks or the links can consist of the
general communications network which in FIG. 4 is symbolized by 80,
one or more specially arranged, for example fixed, links 81 and/or
computer network links 82 which can consist of or include the
Internet. The computer equipment can be connected by the respective
modems to one or more of said networks.
[0043] For his work, the party B (the dental technician or the
dental laboratory) requires a model which images the jaw bone and
the dental prosthesis with an intermediate space between these,
which intermediate space actually corresponds to the space for soft
tissue (gum). This permits insertion of the plastic model in an
articulator (cf. above) for the opposite jaw or in a re-mounting
block. In the virtual model in the computer, the positions for the
fixture installations are planned in advance. Around the holes, or
for forming the holes, sleeves made of solid material are needed to
secure the installation of the fixture in the plastic model. That
part of the plastic model which images the jaw bone is seen in
FIGS. 5 and 6, where the jaw bone model has been indicated by 83 in
FIG. 5. In FIG. 6, a soft-tissue imitation made of soft plastic is
indicated by 84. In accordance with the above, the plastic model is
obtained from the third party. A model or tooth replacement made of
wax with prosthetic teeth made of acrylate is tested out in the
patient's mouth and checked for the appropriate color, shape and
articulation. This too is sent to the dental technician who
produces the jaw-bone bridge in order to allow the acrylate teeth
of the bridge to be transferred to the finished dental bridge. In
addition, the party B receives a plaster model or an impression of
the opposite jaw made of impression material which is not disturbed
during transport to the dental technician. The bite register index
can expediently be made of wax in order to permit registering of
the jaws' bite relationship to each other. The insertion of the jaw
models in the articulator by the dental laboratory or by the
dental. technician must correspond to the bite relationships in the
patient's mouth. Conventional prosthesis wax is advantageous in the
present case. In addition, the second party will obtain a
description of the order, the planned therapy, special
requirements, for example individual characteristics and other
details which concern the work, and the date when the work will be
done at the clinic (at the party A).
[0044] The first party will in accordance with the above be
provided with prosthetic and surgical instruments in accordance
with the above. A plastic model and dental bridge will be
available, likewise the abovementioned basic sets and optional
auxiliary sets. The plastic model is according to the above a model
of the patient's jaw which has been imaged with the aid of
computerized X-ray tomography. In order to permit bite registering
and mounting in the articulator, it also includes the tooth
replacement. With the aid of the computer, the positions of the
seats for the fixtures are determined in advance in accordance with
the above, and the plastic model is then produced with the aid of
stereolithography using an epoxy material in the present
illustrative embodiment. The model images the jaw bone 83 and the
dental prosthesis 85 (see FIG. 6) with said intermediate spaces 86
for soft tissue. The dental prosthesis model is supported on the
jaw-bone model 83 with the aid of pins (not shown) which are
automatically imaged in the program upon production in the
stereolithography process. Suitable fixtures 87 are placed in the
planned holes/seats on the model. An assembly template 88 (see FIG.
5) is produced with the aid of the model. The assembly template
represents a template for drill/fixture RP. In the production of
the model, the holes are strengthened with sleeves 89, and the
arrangement is also such that an expansion spacer 90 and an
expansion screw 91 are included in order to hold the template in a
defined ideal position, even during the actual tightening when the
template is not allowed to tilt in its attachments. The spacer 90
bears against the fixture 87. By means of the template production
process, said template can then be transferred to the patient and
there functions as a hole-forming template which provides a high
degree of precision. During production of the template, the latter
is provided with support parts 88a which bear against the top
surface 83a of the jaw model 83. The extent of the template in or
along the entire extension of the jaw bone, with its
irregularities, means that the template acquires a precise position
in the patient's mouth. In a preferred embodiment, the template
comprises carbon fiber-reinforced plastic.
[0045] In accordance with FIG. 3, a dental bridge is produced from
the plastic model part according to FIG. 6. Special spacers 92
which are intended to be used by the dental laboratory or by the
dental technician are mounted on the fixtures 87 of the model and
cementing sleeves 93 are applied on the spacers. The bridge
skeleton 85 can consist of carbon fiber-reinforced plastic,
titanium or some other dental alloy. The spacers are preferably
made of titanium and in one embodiment have lengths of 3.5 and 5
mm. The spacers are intended to be cemented on the titanium sleeves
93 in the bridge in the patient's mouth and screwed tight to the
fixtures using gold spacer screws 94. Tooth dummies 95 are applied
on the bridge skeleton in a manner known per se.
[0046] The surgeon or equivalent exposes the maxilla at the
mucolabial fold (and not at the top of the maxilla as in this case
it becomes impossible to sew flaps together when the dental bridge
is put in place). When the maxilla is exposed, an assembly template
is applied (in a manner known per se) for drill/fixture on the
dental crest with the aid of the support built on both sides of the
assembly template for drill/fixture. The correct position must be
found in the individual geography of the dental crest. When the
assembly template for drill/fixture RP is sitting in a stable
position, the work on installing fixtures can be started. The
assembly template for drill/fixture is held in place in the correct
position on the dental crest. A drill guide is placed in the actual
sleeve on the assembly template. It is advantageous to choose a
sleeve which is placed at the center over one half of the dental
arch. Another sleeve is then chosen which is situated at the center
of the other half of the arch. The hole-forming work can then be
started. When the holes have been formed, the actual fixture is
applied until contact is reached between the recessed part in the
bone and the fixture. Thereafter, the assembly template is anchored
in the applied fixture with the aid of the expansion spacer, after
which the work on applying the fixture on the other side can
proceed. When this fixture too is anchored, the assembly template
is also secured to this fixture, and when the assembly template has
been screwed on the first two fixtures installed, it is then
possible to continue with installing the remaining fixtures, with
the difference that the assembly template sits more securely in
place. When all the fixtures are installed, the assembly template
is unscrewed, after which the dental bridge can be applied on the
fixtures which have thus been applied. The dental bridge is tested
and, if necessary, adjusted with slight corrections. If, for
example, one of the sleeves in the bridge does not sit exactly on
the fixture, it can be adjusted for example with a round drill.
Thereafter, the dental bridge is cemented, which can be done with
acrylate-based cement. After the cement has hardened, the bridge
can be loosened and temporarily removed. When the flap is sewn back
with the fixtures underneath, the bridge is again applied on the
fixtures through the soft tissue. Any bite grinding on the opposite
jaw can be done, and the screw holes are filled again in the usual
way.
[0047] According to the above, the dental bridge is produced on the
plastic model which has been provided with fixture dummies (cf.
FIGS. 5 and 6). The gum in the intermediate space between the
plastic model and the tooth prosthesis model is produced in
advance. Suitable holes are punched in the gum replacement over the
fixtures, in which spacers of suitable length are mounted. The
sleeves 93 are conical in this illustrative embodiment. The bridge
skeleton 85 is made of carbon fiber-reinforced plastic, cf. said
Swedish Patent 457,691. Hole perforation and sleeve application in
the carbon-fiber bridge are described in more detail in the Swedish
patent applications which were mentioned at the outset and which
were filed on the same day as the present application. The finished
carbon-fiber bridge with inserted sleeves 93 is provided in the
next step with plastic teeth which are secured with fast-acting
adhesive, for example cyanoacrylate, in the respective place in the
silicone casting which is mounted on the patient model with the aid
of rubber bands. Thereafter, a liquid composition (acryl) is
applied between the plastic teeth and around the carbon-fiber
skeleton in accordance with the known routine. This is polymerized
in an acryl polymerization apparatus in water under pressure at a
certain temperature depending on the selected process. After
polymerization and cooling in cold water, the bridge is loosened
and cleaned and bite-ground in the articulator according to the
known routine.
[0048] FIG. 7 shows a jaw (upper jaw) indicated by 96. X-ray
equipment is indicated by 97. A digital signal 98 or first
representation is transmitted on a line or link 99 to the computer
equipment located with the party A. FIG. 7 also shows a loose
prosthesis or a model of a tooth replacement indicated by 100. This
too is read off, for example by computer tomography, laser
scanning, photogrammetry, etc., which transmits to said computer
equipment a digital signal 103 or second representation on a link
104. A user 105 operates the computer terminal 106 in order, by
means of a computer program 107 of a known type, to simulate
virtual images 108 and 109 on the computer screen 110 of said
representations 98 and 103, i.e. of the jaw bone and the loose
prosthesis or model thereof, respectively. The user coordinates the
virtual images and plans optimal applications of virtual fixtures
111, 112 in the actual jaw bone. The coordinated configuration of
jaw bone, prosthesis and fixtures is exported digitally to the
party C in accordance with the above. The signal has in this case
been indicated by 113, while the link has been indicated by 114.
The party C deals, in accordance with the above, with the
production of a plastic model which includes the jaw bone, the
prosthesis (or equivalent) and replacements (tube elements) for the
fixtures or the fixture positions. The model is sent as a parcel
which has been symbolized by the link 115.
[0049] According to the above, the party A also provides the party
B with a model or impression 116 of the patient's lower jaw which
has been symbolized by 117. According to the above, the party B
produces an assembly template 118 for the party A, which template
is used for guiding hole-forming members (drill) 119. Preliminary
drilling 120 has in this case been carried out with a small drill.
FIG. 7 also shows that a fixture 121 has been installed in the jaw
bone 96. An articulator 122 is shown symbolically by 122, in which
the plastic model 123 which was obtained from the party C has been
placed together with the impression 116' which was received from
the party A. The abovementioned space 124 for the soft tissue or
gum is simulated in the articulator. The transfer link for the
impression (of plaster) has been shown by 125.
[0050] In accordance with the invention and FIGS. 8 and 9, a file
system is used for handling customers, orders, production, etc.
This file-handling is intended to be done in a computer
arrangement, but in order to clearly illustrate the functions
outside the computer world, these have been indicated by symbolic
hardware. The system is made up of modules, where one module 126
has been. indicated with a file holder 127 which can be withdrawn
from and inserted into a filing cabinet 128. The file holder
contains a number of files or sections, where a first file has been
indicated as an order file 129, a second file as a finance file
130, a third file as an invoice file 131, a fourth file as a
product or component file 132, and a fifth file as a customer file
133. The content of the file holder 127 can relate to a certain
number of customers, and the module system as a whole is designed
so that incoming customers can be received by expanding the number
of file holders or modules 127. The different file holders have
substantially identical or corresponding contents, and in FIG. 8 an
inserted file holder has been indicated by 134.
[0051] In FIG. 9, the structure of the module system has been
indicated by three cabinets 126', 126" and 126'". The first cabinet
126' contains file holders 127', 134' etc. in accordance with the
above. The cabinets 126" and 126'" have substantially the same or
corresponding structure. The contents of the different cabinets can
be coordinated, which has been symbolized by the link 135, which is
also indicated symbolically. In accordance with FIG. 9, the flow of
incoming orders and the production of products can be separated. In
FIG. 9, an order station, which can be the producer itself or the
customer directly, is indicated by 136. In the present case, an
order document is shown (i.e. an order file) by 137. The document
is transferred in the direction of the arrow 138 to the storage
system which is indicated by 139 and which is arranged between the
order sender and the production function. The transfer 138 takes
place digitally, in accordance with the above, via an electronic
link or wireless communication in a manner known per se. The
production function is indicated by 140, and the production
function can extract or import a document (or a file) 16 to or
from. the storage function 139. The transfer direction for the
document 141 is indicated by 142. This connection too can be wired
or wireless in accordance with the above.
[0052] In accordance with the invention, as is shown in FIG. 10, a
flow chart can be set up for treating an edentulous patient with a
dental plate. The patient is defined with respect to certain
parameters, for example jaw-bone status, age, etc. This definition
takes place in the block 143. Thereafter, the patient's status is
defined in relation to earlier experience in the block 144. This
comparison function can be performed by the surgeon or prosthetist.
Advantages of the desired dental situation are defined in the block
145. This definition takes place on consultation between patient
and surgeon.. A model production, for example production of a drill
model, is defined in block 146. The X-ray situation is defined in
the block 147, for example whether X-ray tomography will be used,
whether this will be done at hospital or by computer tomography.
The production function using preferably three-dimensional CADD
equipment is defined in block 148. If stereolithography equipment
is to be used for producing the model, this is done in block 149. A
plastic model with fixture markings is defined in a block 150.
Thereafter, the dental technician's work is defined in block 151.
Preparations for surgery are defined in block 152. The other
parameters used for data programming are implemented, see
above.
[0053] The invention is not limited to the embodiment described
above by way of example, and instead it can be modified within the
scope of the attached patent claims and the inventive concept.
* * * * *